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SGA – other metabolic risks — RACP Paediatrics MCQ

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HardNeonatalSGA – other metabolic risksRACP Paediatrics

A 3-year-old with no diabetes has a second fasting hypoglycaemic episode, glucose 1.9 mmol/L, lethargy and hepatomegaly. Intravenous access is present. Which investigation-and-treatment sequence is best?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Draw a critical sample, then administer intravenous glucose immediately

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

E is correct. Recurrent unexplained hypoglycaemia with hepatomegaly warrants a critical sample during hypoglycaemia, but sampling must be rapid and must never delay treatment of neuroglycopenia. A loses valuable diagnostic information. B dangerously postpones glucose. C glucagon response can be informative in specialist protocols but does not replace the critical sample or urgent glucose. D the sample requires broader metabolic/endocrine analytes and oral treatment is unreliable in a lethargic child.

Reference: RCH Melbourne, Hypoglycaemia: https://www.rch.org.au/clinicalguide/guideline_index/Hypoglycaemia/